Electronic gaming machines: an integrated mixed-methods examination of the spectrum of gambling-related harms

Abstract

Background: Electronic gaming machine (EGM) is established as a particularly risky form of gambling. The harms of frequent EGM play and problem gambling are many, and negatively affect the individual, families and the broader community. New Zealand is one of the few countries that has incorporated public health approach to gambling harm; however, research suggests that the prevalence rate of problem gambling has plateaued and the gambling harm-minimisation strategies seem to focus on the extreme end of problem gambling with very little focus on health promotion policies. Therefore, there are many prospects of developing a broader and more integrated public health approach, especially for EGM gambling. Aim and objectives: The primary aim of this thesis was to understand EGM gambling behaviour in a holistic manner to make recommendations of potential strategies to minimise EGM gambling-related harms and promote health. This thesis was guided by four main objectives, which are; 1. To explore the association between problem gambling and psychological disorders in EGM gamblers. 2. To develop a comprehensive theoretical framework for EGM gambling behaviour. 3. To understand the challenges related to EGM gambling harm-minimisation and interventions. 4. To provide recommendations for regulatory policy, clinical directives and community actions to minimise EGM gambling harm and improve gambling interventions within the public health approach. Methodology: The thesis undertook three sequential studies for data collection and analysis using mixed methodologies. Study one utilised quantitative online survey methodology on a sample of selfreported EGM gamblers to understand association on co-occurring psychological disorders and problem gambling and its relationship to decision-making. Study two utilised qualitative indepth semi-structured interview method to collect data on experiences and circumstances around EGM play, gambling motives, help-seeking behaviours, reasons to relapse and experience of gambling harm from active EGM gamblers. Similarly, Study three utilised qualitative in-depth interviews method to understand the complexity of EGM gambling behaviour from the perspectives of health professionals, academics and policy-makers in developing EGM gambling harm-minimisation, policies and intervention strategies. Each study informed factors that could impact the onset and course of EGM problem gambling and experience of gambling-related harm to generate a conceptual framework and recommend potential EGM gambling harm-minimisation policies. Discussion: The quantitative data demonstrated higher scores on screening measures including anxiety, depression, stress and alcohol use and poor performance on IGT in problem gamblers. The qualitative analysis further added co-occurring disorders in EGM gamblers contributed to an individual’s vulnerability to a range of issues, such as the compound impact on daily activity (e.g., eating and sleeping patterns), challenges in coping with gambling harm (e.g., breakdown of relationship) and added complications to seeking help. A biopsychosocial framework to EGM gambling behaviour was developed showing interconnected risk factors (environmental, individual and the structural characteristics of EGMs), the process of PG recovery and EGM gambling-related harm. The framework further facilitated understanding of challenges related to the EGM gambling harm-minimisation such as; high concentration of EGMs particularly in socially deprived areas, sophisticated structural characteristics of EGMs, social regulatory policies such as community funding model of EGM gambling proceeds and new challenges related to increasing online EGM gambling engagement. Consequently, multiple-level approaches were recommended, including broader cross-sector collaboration to improve knowledge on gambling-related harm, empower vulnerable populations and change lifestyles to include community involvement. Conclusion: This thesis contributes to the public health debate around EGM gambling by building on the existing gambling literature. It uses a range of mixed model techniques which have not before been used in this context. Together, the chapters of this thesis form a conceptual model which outlines the interaction between the different variables that enhances gambling behaviour and experience of harm and is followed by a range of policy and clinical implications aimed at reducing gambling harm and suggestions for several future research areas.